Psychiatry International

Rapid innovation-driven transitions have, across successive eras, been associated with increased psychological distress, substance use, and suicide when social and economic change outpaces the adaptive capacity of individuals, communities, institutions, and governments. The early artificial intelligence (AI) economy is emerging at an unprecedented pace, reshaping education, employment, and social organization in ways that may intensify these risks, particularly among young people. This perspective argues that school-based mental health nursing, working collaboratively with school psychologists, counsellors, physicians, and other interdisciplinary professionals, represents a practical upstream response to AI-era disruption. Drawing on historical evidence from the Industrial Revolution, population mental health research, and the contemporary mental health nursing literature, the paper examines the mechanisms through which rapid socio-economic change may contribute to psychological distress and substance-use problems. It further distinguishes AI as both a source of socio-economic disruption and a clinical tool that can support—but not replace—relationship-based nursing practice. Strengthening school-based mental health nursing within interdisciplinary systems offers a practical, prevention-oriented strategy to promote resilience, facilitate early intervention, and mitigate downstream mental health and substance-use harms during the AI transition. Full article

The digital transformation of work has increasingly blurred the temporal, spatial, and psychological boundaries between professional and personal life. As a result, structural conditions have emerged that are associated with an elevated risk of burnout. This narrative review draws on literature identified through searches of Web of Science, Scopus and PubMed covering publications from 2004 to early 2026, which yielded 36 included studies, supplemented by further sources identified outside that search. It integrates key theoretical perspectives, including boundary theory, the Areas of Worklife model, the Job Demands-Resources framework and Conservation of Resources theory. Across diverse occupational contexts, three pathways recur: rising work-family conflict, reduced ability to psychologically detach from work during non-work time and the gradual depletion of personal resources. Structural drivers, comprising organisational availability norms, leadership behaviour, technology and platform design, workload, and economic precarity, are treated as the conditions under which exposure arises, and the review argues that responses pitched at individual coping are correspondingly limited. The public health implications extend beyond mental health, encompassing cardiovascular risk associated with long working hours, strain on healthcare systems, productivity losses and widening health inequities along gendered and socioeconomic lines. Addressing these challenges requires multilevel interventions, including organisational job redesign, leadership development, enforceable right-to-disconnect policies and greater recognition of recovery as a public health priority. At the same time, there remains a need for more longitudinal and intervention-based research, particularly in non-Western contexts. Full article

Background: Problematic smartphone use (PSU) and problematic social media use (PSMU) are common among university students, but little is known about whether distinct patterns of use exist. This study identified profiles of smartphone and social media use among French university students and examined factors associated with profile membership. Methods: An online survey was completed by 973 students from two French universities. K-means cluster analysis was conducted using smartphone use frequency, problematic smartphone use, social media use frequency, and problematic social media use. Multinomial logistic regression identified sociodemographic, social, psychological, mental well-being, and academic predictors of profile membership. Results: Three profiles emerged: low-risk (36.6%), moderate-risk (44.5%), and high-risk (18.9%). Compared with the low-risk profile, the moderate- and high-risk profiles were associated with younger age, higher neuroticism, greater positive urgency impulsivity, more attentional difficulties, and greater smartphone-related academic interference. Higher conscientiousness is consistently associated with likelihood of belonging to higher-risk profiles. Greater commitment in intimate relationships and stronger future-self continuity significantly predicted membership in the low-risk profile. Conclusions: PSU and PSMU comprise distinct behavioral profiles. Modifiable factors, including impulsivity, conscientiousness, future-self continuity, and academic digital habits, may help identify and support students at greater risk. Full article

Social media increases opportunities for appearance-based social comparison, which may negatively impact body image and affective well-being. However, limited research has addressed how individual characteristics, such as depressive symptoms and dispositional mindfulness, influence susceptibility to these effects. Guided by the Differential Susceptibility to Media Effects Model (DSMM), the present study examined a framework connecting depressive symptoms, facets of mindfulness, appearance-based social comparison, body image positivity, and affective well-being. This study explored depressive symptoms and acting with awareness in relation to appearance-based social comparison. Additionally, it evaluated whether nonjudgment moderates the association between appearance-based social comparison and body image positivity. A total of 341 undergraduate students at a Canadian university participated in a cross-sectional online survey. In line with the DSMM, depressive symptoms and acting with awareness were indirectly associated with affective well-being. Higher depressive symptoms were associated with increased appearance-based social comparison, which was associated with lower body image positivity and, in turn, poorer affective well-being. Greater acting with awareness was related to reduced appearance-based social comparison. Nonjudgment did not moderate the relationship between appearance-based social comparison and body image positivity. These findings enhance understanding of individual differences in appearance-based social comparison on social media and suggest directions for future research on interventions that promote healthier social media experiences. Full article

Digital technologies have become an essential part of modern workplaces, improving communication, efficiency, and organisational processes. However, excessive and uncontrolled use of digital technologies may negatively affect employees’ well-being and workplace productivity. This narrative literature review examines the relationship between digital addiction and workplace productivity by focusing on the individual, social, and organisational consequences of problematic digital technology use. The study first defines the concepts of digital addiction and workplace productivity to establish a conceptual framework. It then discusses how problematic digital technology use, including excessive internet use, social media use, smartphone use, screen use, gaming disorder, and online gambling, may influence productivity through distraction, reduced concentration, poor time management, stress, health problems, and impaired work–life balance. The review highlights that digital technologies are not inherently harmful; rather, productivity problems arise from uncontrolled and problematic patterns of use. The study concludes by suggesting organisational and individual-level interventions, including digital awareness training, responsible technology use policies, improved time management practices, and supportive workplace environments to reduce the negative effects of digital addiction. Full article

Loneliness and social isolation are related but distinct experiences, and their relative contributions to mental health among men who have sex with men (MSM) remain insufficiently studied in Portugal. This cross-sectional online survey of 641 cisgender MSM (age 18–74 years; M = 38.51, SD = 12.83) examined associations among loneliness, objective connectivity, interpersonal belonging, LGBTQIA+ community belonging, social-network composition, negative affect, and psychological distress, using the UCLA Loneliness Scale, the Social Isolation Scale, the Depression Anxiety Stress Scales-21, and a short Portuguese Positive and Negative Affect Schedule. LGBTQIA+ community belonging and LGBTQIA+ network representation were assessed with single items. Correlations, multiple regressions, and two moderation models were estimated with heteroscedasticity-consistent standard errors and sensitivity analyses. Loneliness was the strongest independent correlate of psychological distress (β = 0.509, p < 0.001, R² = 0.353) and negative affect (β = 0.398, p < 0.001, R² = 0.193). Interpersonal belonging showed a small, borderline inverse association with distress (β = −0.10, p = 0.050) that did not survive covariate adjustment. Neither LGBTQIA+ community belonging nor LGBTQIA+ network representation moderated the loneliness–distress association. Subjective loneliness was more closely tied to distress than objective connectivity or broad community integration. These cross-sectional findings are consistent with the value of examining interventions that address the quality and reciprocity of close relationships alongside affirming community resources. Full article

Early parental loss may increase depression risk among orphaned university students, yet evidence from low- and middle-income countries such as Thailand remains limited. This cross-sectional study examined depressive symptoms and their associations with attachment insecurity, resilience, inner strength, and perceived social support among 226 Thai university students aged ≥20 years who had lost one or both biological parents before age 18. Participants completed validated Thai versions of the Outcome Inventory–Depression subscale, the Experiences of Close Relationships–Revised 10-item version, the 9-item Resilience Inventory, the Inner Strength-Based Inventory, and the revised Thai Multidimensional Scale of Perceived Social Support. Multiple linear regression identified factors associated with depressive symptoms. The mean depression score was 6.62, with no significant difference between single and double orphans. Attachment anxiety (β = 0.176, p = 0.002) was significantly and positively associated with depressive symptoms, whereas resilience (β = −0.322, p < 0.001), inner strength (β = −0.192, p < 0.003), and perceived social support (β = −0.156, p = 0.022) were significantly and negatively associated with depression. In contrast, attachment avoidance (β = 0.110, p = 0.068) did not reach statistical significance. Among orphaned students, depressive symptoms were more closely linked to psychosocial factors than to the specific type of parental loss (single vs. double orphanhood). Full article

Introduction: Nurses in hospital settings frequently experience anxiety, which may adversely affect both their psychological well-being and professional functioning. In this context, Professional Quality of Life (ProQoL) and Meaning in Life are recognized as key factors influencing nurses’ mental health outcomes. Aim: The aim of the present study was to explore the level of anxiety among nursing personnel in hospital settings and to assess its association with ProQoL and Meaning in Life. Materials and Methods: A cross-sectional study was conducted in a convenience sample of 200 nursing personnel in a public hospital. Data were collected using the Zung Self-Rating Anxiety Scale (SAS), the Professional Quality of Life Scale-5 (ProQoL-5), and the Meaning in Life Questionnaire (MLQ) which also included characteristics of nursing personnel. Results: Anxiety levels were low to mild (39.8 ± 8.7). ProQoL dimensions indicated moderate to high Compassion Satisfaction (35.5 ± 7.3) and moderate levels of Burnout (27.6 ± 5.7) and Secondary Traumatic Stress (26.5 ± 6.1). Regarding Meaning in Life, participants reported high levels of Presence of Meaning (27.1 ± 4.8) and moderate levels of Search for Meaning (21.7 ± 6.7). A statistically significant negative correlation was observed between anxiety and Compassion Satisfaction (r = −0.532, p < 0.001), as well as between anxiety and Presence of Meaning (r = −0.387, p < 0.001). In contrast, anxiety was positively correlated with Burnout (r = 0.652, p < 0.001) and Secondary Traumatic Stress (r = 0.534, p < 0.001). In the multivariable analysis, the self-rating of daily work experience score was associated with increased anxiety levels by 0.9 units for each unit increase (95% CI: 0.2 to 1.7, p < 0.011). Compassion Satisfaction was associated with a decrease in anxiety by 0.4 units (95% CI: −0.6 to −0.2, p < 0.001), while Burnout and Secondary Traumatic Stress were associated with an increase in anxiety by 0.5 (95% CI: 0.2 to 0.8, p < 0.001) and 0.4 units (95% CI: 0.2 to 0.6, p < 0.001), respectively. Conclusions: Self-rated daily work experience, Burnout, and Secondary Traumatic Stress were positively associated with anxiety, whereas Compassion Satisfaction was negatively associated with anxiety. These results illustrate the importance of targeted interventions aimed at reducing anxiety, strengthening ProQoL, and promoting Meaning in Life to support nursing personnel’s well-being. Full article

Background: Mental health is the main factor of the overall quality of life of both individuals and the community. In contemporary society, mental health is gaining more and more significance, although there is still an insufficient level of awareness among people about what factors can affect our mental health and why it is of such importance for daily functioning. Material: The research used an anonymous questionnaire created by a team of doctors from the Clinic for Psychiatry in Novi Sad with the aim of assessing how the ongoing social situation in Serbia affects the mental health of the population. Results: It was shown that there is a statistically significant link between levels of feeling tense and following the news about the ongoing protests. The research has shown that there are statistically significant differences in emotional response in relation to gender and age resulting from the current situation. A statistically significant association between sleep problems and the use of anxiolytic therapy has been proven. Most of the respondents declared that the current situation in which we live has a negative impact on mental health. Conclusions: The results of the research indicate that social circumstances in Serbia significantly affect the psychological functioning of the population. Full article

Background: Hospitalization and incarceration are distinct institutional experiences, but both may involve reduced autonomy, externally regulated routines, uncertainty, restricted privacy, and disruption of meaningful social relationships. This systematic review examined shared and setting-specific psychological outcomes and associated factors across the two environments. Methods: PubMed, Scopus, Web of Science and the Cochrane Library were searched from database inception to 30 January 2026. Of 1149 identified records, 22 studies met the eligibility criteria. Methodological quality was assessed using the Mixed Methods Appraisal Tool 2018, and findings were synthesized narratively because substantial clinical and methodological heterogeneity precluded meta-analysis. Results: Ten studies examined incarcerated populations and twelve examined hospitalized populations. Across incarceration studies, reported estimates ranged from 14.9% to 72.6% for depressive symptoms or mood disorders and from 23.3% to 77.8% for anxiety symptoms or disorders. Across hospitalization studies, corresponding estimates ranged from 5.1% to 41.0% and from 5.8% to 60.0%, respectively. These ranges reflect heterogeneous screening instruments, diagnostic procedures, populations, and outcome definitions and were not statistically pooled. In both settings, poorer psychological outcomes were associated with reduced perceived control, disrupted routines, uncertainty, limited social support, and individual vulnerability. Setting-specific factors included prison climate, coping style, shame, and sentence-related circumstances in incarceration, and illness severity, functional impairment, prognostic uncertainty, isolation precautions, and prolonged or repeated admission in hospitalization. Findings concerning exposure duration were inconsistent in both settings. Conclusions: Hospitalization and incarceration should not be regarded as psychologically equivalent. Nevertheless, they may share experiential conditions associated with distress, particularly when autonomy, privacy, predictability, and social connectedness are reduced. Because the evidence was heterogeneous and predominantly observational, causal conclusions and direct quantitative comparisons cannot be made. Full article

Trauma is a condition that overwhelms an individual’s capacity to cope, disrupting emotional regulation, cognitive functioning, and the sense of safety. Complex trauma, characterized by prolonged and interpersonal adverse experiences, is associated with significant psychological distress, including anxiety, dissociation, and difficulties in self-regulation. Neurobiological research highlights how trauma is encoded not only cognitively but also within the body, through autonomic nervous system dysregulation and procedural memory processes, often resulting in states of hyperarousal or hypoarousal and a narrowed window of tolerance. The aim of this narrative review is to synthesize and critically examine the current literature on somatic-based interventions for the treatment of trauma, with a particular focus on Sensorimotor Psychotherapy, Somatic Experiencing, and related body-oriented approaches. In this context, somatic-based interventions offer a bottom–up approach that directly targets physiological and sensorimotor processes. Modalities such as Sensorimotor Psychotherapy and Somatic Experiencing aim to restore autonomic balance, enhance body awareness, and support the integration of traumatic experiences. This narrative review synthesizes current evidence, suggesting that these approaches can improve emotional regulation, dissociation, and overall trauma-related symptoms, particularly in individuals with complex trauma. Despite promising findings, the literature is limited by methodological variability and a lack of rigorous trials. Further research is needed to strengthen the evidence base and clarify mechanisms of change. Overall, somatic interventions represent a valuable complement to traditional trauma therapies, supporting a more integrated and embodied approach to treatment. Full article

Gambling disorder (GD) is associated with severe psychosocial impairment, impulsive dyscontrol, affective instability, and increased suicidal risk. Pharmacological options remain limited, particularly for patients whose presentation is dominated by transdiagnostic dimensions such as impulsivity, emotional dysregulation, and suicidal vulnerability. Lithium may be relevant because of its anti-suicidal properties and potential effects on affective instability and behavioral dyscontrol. We describe a 40-year-old man with sports-betting-related GD who presented after a suicidal crisis in the context of financial collapse and marital conflict. He entered a structured multimodal program including psychiatric care, lithium carbonate, individual psychotherapy, psychoeducational and self-help groups, family intervention, and social support. During multimodal treatment, which included lithium carbonate titrated to 600 mg/day, the patient was observed to show progressive affective stabilization, remission of suicidal ideation, reduced gambling urges, and sustained abstinence, with one brief lapse that was rapidly contained. Psychometric reassessment showed selective improvement across gambling-related and functional domains, including reduced functional impairment and markedly reduced gambling-related cognitive distortions; however, global psychopathological distress remained substantially stable, and the GPQ subtype shift was interpreted only descriptively. Although causal inference is limited by the single-case design and multimodal treatment context, this case raises the hypothesis that lithium may have contributed, within a multimodal intervention, to the stabilization of core vulnerability dimensions in selected GD presentations, particularly impulsivity, affective dysregulation, and suicidality. Full article

(1) Background: Depression, anxiety, and diabetes-related distress commonly coexist in adults with diabetes and may contribute to cumulative psychosocial burden. This study examined the prevalence of multi-psychosocial burden and its association with chronic diabetes-related complications. (2) Methods: A cross-sectional study was conducted among 172 adults with diabetes using the Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, and Diabetes Distress Scale. Multi-psychosocial burden was defined as the presence of at least two positive psychosocial conditions. Sociodemographic and clinical data were collected through structured assessment and medical record review. (3) Results: The mean age was 58.3 ± 10.4 years, and 57.6% were female. Overall, 16.9% of participants met criteria for multi-psychosocial burden. Chronic diabetes-related complications were present in 47.7% of participants. Each additional chronic complication was independently associated with higher odds of multi-psychosocial burden (adjusted OR 1.92, 95% CI 1.21–3.05; p = 0.005). The prevalence of multi-psychosocial burden increased from 8.9% among participants without complications to 37.9% among those with two or more complications, demonstrating a dose-dependent pattern. (4) Conclusions: Chronic complication burden was independently associated with concurrent psychosocial conditions in adults with diabetes, supporting the importance of routine psychosocial screening in patients with chronic complications, while future longitudinal studies are needed to clarify causal pathways. Full article

Background/Objectives: Suicide remains a major public health concern, with over 700,000 deaths annually worldwide. Current risk assessment is limited by the tendency of at-risk patients to deny suicidal ideation, with denial rates of approximately 50% among ideators and up to 78% among inpatient suicide decedents. Methods: This proof-of-concept study investigated whether deep learning applied to patient speech could distinguish psychiatric inpatients admitted following a recent suicide attempt from patients with severe depression without documented suicidal ideation. A multi-scale two-dimensional convolutional neural network with residual connections and spatial attention (Multi-Scale CNN) was trained on mel-spectrograms generated exclusively from patient speech extracted by automatic speaker diarization followed by manual verification. The dataset comprised recordings from 88 psychiatric inpatients (59 suicide attempters and 29 patients with severe depression without suicidal ideation). Model performance was evaluated using repeated patient-level stratified five-fold cross-validation, ensuring complete separation of participants between folds. Additional female-only, exploratory male-only, and repeated sex-matched analyses were performed to evaluate the potential influence of sex imbalance. Results: Repeated patient-level five-fold cross-validation yielded a mean classification accuracy of 72.7 ± 6.4% with a mean ROC-AUC of 0.824 ± 0.054, a sensitivity of 88.3 ± 9.5%, and a specificity of 41.3 ± 25.0%. Female-only analysis maintained good discriminative performance (ROC-AUC 0.866 ± 0.123), whereas repeated sex-matched analyses produced lower performance (ROC-AUC 0.621 ± 0.156), indicating that sex imbalance contributed to, but did not fully explain, the observed discrimination. The male-only analysis was considered exploratory because of the limited number of male patients in the depression group. Conclusions: These findings support the feasibility of voice-based patient-level analysis as a complementary objective approach for suicide risk assessment. Although the study remains exploratory because of the limited sample size and the absence of external validation, the revised validation strategy and sex-controlled analyses provide a substantially more robust estimate of model performance. Further multicenter prospective studies are required before clinical implementation. Full article

Background: Police and security professionals are routinely exposed to potentially traumatic events as part of occupational duties, placing them at increased risk for post-traumatic stress and broader psychological difficulties. This study aimed to identify latent classes of proximal traumatic exposure among Portuguese police/security professionals and examine their associations with PTSD symptoms and general psychological distress. Methods: A cross-sectional online survey was conducted with Portuguese police/security professionals (N = 644). Latent class analysis (LCA) was applied to 17 indicators of potentially traumatic events coded as directly experienced or witnessed, derived from the Life Events Checklist for DSM-5. PTSD symptoms were assessed using the PTSD Checklist for DSM-5, and general psychological distress was assessed using the Brief Symptom Inventory. Exploratory receiver operating characteristic (ROC) analyses examined whether counts of proximal traumatic events could approximate the LCA-derived classes. Results: A three-class solution was identified, comprising low proximal exposure (37.3%), moderate proximal exposure (40.7%), and high proximal/cumulative exposure (22.0%) classes. The classes reflected a graded cumulative pattern of exposure across traumatic event categories, rather than clearly distinct qualitative configurations defined by specific event types. Higher exposure classes were associated with progressively higher PTSD symptoms and psychological distress, and these associations remained significant after adjustment for sociodemographic and occupational variables. Exploratory receiver operating characteristic (ROC) analyses showed that a simple count of proximal traumatic event categories closely approximated the empirically derived class structure within the present sample. However, the resulting thresholds are sample-specific, exploratory, and should not be interpreted as validated screening cutoffs. Conclusions: Proximal traumatic exposure among police/security professionals appears to follow a graded cumulative structure associated with increased PTSD symptoms and psychological distress. The person-centered analysis provided an empirical test of whether exposure was organized according to qualitatively distinct event configurations or primarily along a cumulative gradient. In this sample, cumulative exposure burden emerged as the dominant organizing dimension. The count-based approximation requires external validation before any screening or decision-making application can be considered. Full article

Background: This study aimed to investigate whether individuals with trichotillomania (TTM) are at a higher risk of engaging in self-harm behaviors compared to those without TTM. Methods: In this matched cohort study, we analyzed electronic health records of all patients admitted to public hospitals in Hong Kong from 1 January 1993 to 31 December 2022. We identified a TTM cohort of 285 patients and a comparison cohort of 285 individuals. All participants were followed up until they received a diagnosis of self-harm, died from other causes, or until the end of 2023, whichever came first. To assess the risk of self-harm following TTM onset, Cox proportional hazards regression models were applied. Results: Throughout the 30-year study period, the number of individuals who exhibited self-harm behavior in the TTM and comparison groups was 8 (2.8%) and 8 (2.8%), respectively. The TTM and comparison groups had similar proportions of subjects who inflicted self-harm (χ² = 0.00, p = 0.977). The incidence of self-harm was 26.00 and 26.92 per 10,000 person-years in the TTM and comparison groups, respectively. Compared with the comparison group, the adjusted hazard ratio for self-harm in the TTM group was 1.44 (95% confidence interval, 0.45–4.61). Conclusions: TTM is not associated with an increased risk of self-harm. Future research is necessary to replicate our findings and more fully elucidate the potential unique risk factors for self-harm in these patients. Full article

Most instruments used to assess depression have been developed in sociocultural contexts that differ substantially from those of Spanish-speaking Latin American populations. To address this limitation, the present study developed and evaluated a new brief measure of depressive symptomatology for use in northeastern Mexico. The study included 414 participants (Mage = 27.37 years, SD = 13.72). An initial pool of 23 items, grounded in interbehavioral psychology, was developed and subsequently evaluated by a panel of 58 expert judges. Based on content-validity analyses, the instrument was reduced to 15 items. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) supported a final four-item, one-factor solution. The final model demonstrated adequate fit to the data (χ²/df = 0.281, AGFI = 0.993, NNFI = 1.015, CFI = 1.000, RMSEA = 0.000, 90% CI [0.000, 0.094], and SRMR = 0.008). Evidence of discriminant and convergent validity was supported by a negative correlation with the Subjective Happiness Scale (r = −0.294, p < 0.01) and a positive correlation with the seven-item version of the Center for Epidemiologic Studies Depression Scale (CESD-7; r = 0.273, p < 0.01). Construct reliability was satisfactory (H = 0.841). Overall, the findings provide preliminary evidence supporting the reliability and validity of the proposed instrument as a brief screening measure of depressive symptomatology in a Mexican sample, mostly from Nuevo León. Full article

There is growing evidence on the use of pitolisant for the treatment of residual excessive daytime sleepiness (EDS) in adults with obstructive sleep apnea (OSA) treated with continuous positive airway pressure (CPAP). We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing pitolisant to a placebo in adults with OSA and residual EDS despite CPAP use. The primary outcome was a change in subjective sleepiness measured on any validated scale. Secondary outcomes included all-cause discontinuation and treatment-emergent adverse events (TEAEs). A random-effects model was used to calculate standardized mean differences (SMDs) and pooled Log risk ratios (Log RRs). Three RCTs (N = 721) were included. Pitolisant significantly reduced Epworth Sleepiness Scale scores (SMD = −0.90, 95% CI = −1.29 to −0.50; low certainty). There were no significant differences between pitolisant and a placebo for all-cause discontinuation (Log RR = −0.27, 95% CI = −1.60 to 1.06; low certainty) or TEAEs (Log RR = 0.04, 95% CI = −0.19 to 0.27; low certainty). The most common adverse events reported while using pitolisant were headache and insomnia. These findings show emerging potential for pitolisant as a therapeutic option in this population. Future studies should include larger sample sizes and objective measures of sleepiness. Full article

This article proposes a general integrative model focusing on psychological control and psychological reserve. The former refers to internal psychological control and external psychological control. Internal psychological control refers to the management of physiological processes associated with arousal and panics. Here, the concept of internal psychological control is differentiated into two components: cognitive control/executive function and self-control/emotional regulation. External psychological control refers to the sense the person has of being able to manage, have agency in, and otherwise not be overwhelmed by the external context in which one is adapting functionally. Here, the concept of external psychological control is differentiated into two major sub-components: managing reactivity to external events, such as to daily stressors or extreme events, e.g., natural disasters, and proactively taking steps to have agency in and using predictive processing to adjust to context by mitigating the probability of experiencing overwhelming events. Psychological reserve refers to the fluid state reservoir of mental, cognitive, emotional, motivational, and stress management/coping space that is available for use in confronting ongoing and new stressors, challenges, or difficulties. Here, this article differentiates psychological reserve into phases of depletion and recovery. This article examines prior work on psychological control and reserve, demonstrating how they can be understood or modified based on the present sub-component differentiation of the concepts involved. The revised model is applied to understanding psychotherapeutic change mechanisms, a biopsychosocial model of the mechanisms, an integrated functional adaptational model, posttraumatic stress disorder, a unified model for psychotherapy and psychology generally, and clinical recommendations. Full article